ELO Request Form

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ELO Request Form

Complete this form to begin the Extended Learning Opportunity (ELO). This must be completed first before submitting an agreement form.

Email *

Today's Date *

YYYY

Student Name *

Student Email Address *

Student Phone Number *

Graduation Date *

Reason for Requesting an ELO *

Check all that apply

I want to work independently, outside of class time, on a task/project

I want to advance my learning in a particular subject are

I want to explore a career field

I want to participate in an internship

I want to design my own project/learning experience

Other:

Required

Rationale for ELO request *

What is it that you want to do/learn and why? How will this experience benefit you in the future?

Name of the Community Mentor or PHS Teacher you would like to work with during this ELO *

If you will be off campus, do you have access to your own transportation? *

Yes

When would you like to start the ELO? *

Fall Semester

Spring Semester

Summer

Other

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This form was created inside of Pattonville School District.